Per oral bleeding: rare presentation of gardner-diamond syndrome

A 10-year boy presented with spontaneous episodes of oral bleeding for the last 6 months. Detailed ENT examination showed no pathology, bleeding profile was normal, endoscopy and dental examination also did not reveal any abnormality. Child abuse or malingering was also ruled out. Initially the child was managed with platelet transfusion and fresh frozen plasma and then put on follow-up treatment with antifibrinolytics, Vitamin C but the episodes became recurrent. Psychiatric evaluation revealed that child was suffering from depression. Antidepressants were prescribed by the psychiatrist that not only cured the depression with time but also the bleeding episodes which were actually related to child's depression [Gardner-Diamond syndrome or psychogenic purpura]. This is a diagnosis by exclusion where the patients bleed due to dysregulated steroid secretion secondary to stress; resulting in development of sensitization to RBC membrane, and dysregulated fibrinolytic system activity

Haematological changes associated with typhoid fever

To determine haematological changes associated with typhoid fever. This study was conducted at King Edward Medical University, Lahore from March 2010 to March 2011. A total of 150 patients with confirmed diagnosis of Typhoid fever on the basis of Widal test or Typhidot test were enrolled in the study. CBC, peripheral smear, reticulocyte count, PT, APTT, FDPs and D-Dimers were performed on all the patients. Bone marrow biopsy was performed on 48 patients as a part of work up for pancytopenia and to get a bone marrow culture. Data was analyzed by SPSS. T test was applied to determine significant differences between quantitative variables and qualitative clinical data was compared using Chi square test. Cytopenias were found in 98% of the patients. Bone marrow showed prominent hemophagocytic activity in 100% of the patients. PT and APTT was also deranged in 48% of the patients. Typhoid fever affects hematological parameters significantly and these parameters may help not only in making the diagnosis but also help to guide management